Noninvasive multi-parameter patient monitor

ABSTRACT

Embodiments of the present disclosure include a handheld multi-parameter patient monitor capable of determining multiple physiological parameters from the output of a light sensitive detector capable of detecting light attenuated by body tissue. For example, in an embodiment, the monitor is capable of advantageously and accurately displaying one or more of pulse rate, plethysmograph data, perfusion quality, signal confidence, and values of blood constituents in body tissue, including for example, arterial carbon monoxide saturation (“HbCO”), methemoglobin saturation (“HbMet”), total hemoglobin (“Hbt”), arterial oxygen saturation (“SpO2”), fractional arterial oxygen saturation (“SpaO2”), or the like. In an embodiment, the monitor displays a line associated with a patient wellness level.

PRIORITY CLAIM

The present application is a continuation of U.S. application Ser. No.13/412,428, filed Mar. 5, 2012, entitled “Noninvasive Multi-ParameterPatient Monitor,” which is a continuation of U.S. application Ser. No.11/366,208, filed Mar. 1, 2006, entitled “Noninvasive Multi-ParameterPatient Monitor,” which claims priority benefit under 35 U.S.C. §119(e)to U.S. Provisional Patent Application Ser. No. 60/657,596, filed Mar.1, 2005, entitled “Multiple Wavelength Sensor,” No. 60/657,281, filedMar. 1, 2005, entitled “Physiological Parameter Confidence Measure,” No.60/657,268, filed Mar. 1, 2005, entitled “Configurable PhysiologicalMeasurement System,” and No. 60/657,759, filed Mar. 1, 2005, entitled“Noninvasive Multi-Parameter Patient Monitor.” The present applicationincorporates the foregoing disclosures herein by reference.

INCORPORATION BY REFERENCE OF RELATED UTILITY APPLICATIONS

The present application is related to the following U.S. utilityapplications:

Application Ser. No. Filing Date Title 1 11/367,013 Mar. 1, 2006Multiple Wavelength Sensor Emitters 2 11/366,995 Mar. 1, 2006 MultipleWavelength Sensor Equalization 3 11/366,209 Mar. 1, 2006 MultipleWavelength Sensor Substrate 4 11/366,210 Mar. 1, 2006 MultipleWavelength Sensor Interconnect 5 11/366,833 Mar. 1, 2006 MultipleWavelength Sensor Attachment 6 11/366,997 Mar. 1, 2006 MultipleWavelength Sensor Drivers 7 11/367,034 Mar. 1, 2006 PhysiologicalParameter Confidence Measure 8 11/367,036 Mar. 1, 2006 ConfigurablePhysiological Measurement System 9 11/367,033 Mar. 1, 2006 NoninvasiveMulti-Parameter Patient Monitor 10 11/367,014 Mar. 1, 2006 NoninvasiveMulti-Parameter Patient Monitor

The present application incorporates the foregoing disclosures herein byreference.

FIELD OF THE DISCLOSURE

The present disclosure relates to the field of noninvasive patientmonitors. More specifically, the disclosure relates to monitorsdisplaying measurements derived using signals from optical sensors.

BACKGROUND

Spectroscopy is a common technique for measuring the concentration oforganic and some inorganic constituents of a solution. The theoreticalbasis of this technique is the Beer-Lambert law, which states that theconcentration c_(i) of an absorbent in solution can be determined by theintensity of light transmitted through the solution, knowing thepathlength d_(λ), the intensity of the incident light I_(0,λ), and theextinction coefficient ε_(i,λ) at a particular wavelength λ. Ingeneralized form, the Beer-Lambert law is expressed as:

$\begin{matrix}{I_{\lambda} = {I_{0,\lambda}{\mathbb{e}}^{{- d_{\lambda}} \cdot \mu_{0,\lambda}}}} & (1) \\{\mu_{0,\lambda} = {\sum\limits_{i = 1}^{n}{ɛ_{i,\lambda} \cdot c_{i}}}} & (2)\end{matrix}$

where μ_(0,λ) is the bulk absorption coefficient and represents theprobability of absorption per unit length. The minimum number ofdiscrete wavelengths that are required to solve Equations 1-2 are thenumber of significant absorbers that are present in the solution.

A practical application of this technique is pulse oximetry, whichutilizes a noninvasive sensor to measure oxygen saturation (SpO₂) andpulse rate. In general, the sensor has light emitting diodes (LEDs) thattransmit optical radiation of red and infrared wavelengths into a tissuesite and a detector that responds to the intensity of the opticalradiation after absorption (e.g., by transmission or transreflectance)by pulsatile arterial blood flowing within the tissue site. Based onthis response, a processor determines measurements for SpO₂, pulse rate,and can output representative plethysmographic waveforms. Thus, “pulseoximetry” as used herein encompasses its broad ordinary meaning known toone of skill in the art, which includes at least those noninvasiveprocedures for measuring parameters of circulating blood throughspectroscopy. Moreover, “plethysmograph” as used herein (commonlyreferred to as “photoplethysmograph”), encompasses its broad ordinarymeaning known to one of skill in the art, which includes at least datarepresentative of a change in the absorption of particular wavelengthsof light as a function of the changes in body tissue resulting frompulsing blood.

Pulse oximeters capable of reading through motion induced noise areavailable from Masimo Corporation (“Masimo”) of Irvine, Calif. Moreover,portable and other oximeters capable of reading through motion inducednoise are disclosed in at least U.S. Pat. Nos. 6,770,028, 6,658,276,6,157,850, 6,002,952, and 5,769,785. Read which are owned by Masimo, andare incorporated by reference herein. Such reading through motionoximeters have gained rapid acceptance in a wide variety of medicalapplications, including surgical wards, intensive care and neonatalunits, general wards, home care, physical training, and virtually alltypes of monitoring scenarios.

SUMMARY

Despite the success of read through motion oximeter systems, there is aneed to provide patient monitors capable of displaying multiplephysiological parameters, other than or in addition to SpO₂,plethysmograph waveforms, or pulse rates. For example, in accessing apatient's condition, caregivers often desire knowledge of other bloodconstituents, including for example, a percent value for arterial carbonmonoxide saturation (“HbCO”) or a percent value for methemogobinsaturation (“HbMet”) or the like. For example, in an embodiment, thedisplay advantageously displays one or more of the following: pulserate, plethysmograph waveform data, perfusion index, values of bloodconstituents in body tissue, including for example, HbCO, HbMet, totalhemoglobin (“Hbt”), arterial oxygen saturation (“SpO₂”), fractionalarterial oxygen saturation (“SpaO₂”), or the like. In other embodiments,the monitor may advantageously and accurately determine values for oneor more of HbO₂, Hb, blood glucose, water, the presence or absence oftherapeutic drugs (aspirin, Dapson, nitrates, or the like) orabusive/recreational drugs (methamphetamine, alcohol, steroids, or thelike), concentrations of carbon dioxide (“CO₂”) or oxygen (“O”), phlevels, bilirubin, perfusion quality, signal quality or the like.Accordingly, the present disclosure includes a multi-parameter patientmonitor capable of determining one or more of the foregoing parameters,other than or in addition to, SpO₂, plethysmograph waveforms, orperfusion quality index.

In an embodiment, the display of a noninvasive multi-parameter patientmonitor advantageously includes a plurality of display modes enablingmore parameter data to be displayed than the available physical displayarea or real estate. In an embodiment, a user may cycle differentparameter values through an area of the display common to bothparameters even when one parameter is shifted, through, for example,actuation of a user input key. The patient monitor may also displaydifferent parameters as color-coded. For example, when the followingmeasured parameters are within “normal” ranges, SpO₂ may be displayedred, pulse rate (BPM) may be displayed green, HbCO may be displayedorange, HbMet may be displayed blue, or the like. In an embodiment,measured values of SpO₂ may be displayed in white, BPM may be displayedin yellow green or aquamarine, PI™ be displayed in violet, Hbt may bedisplayed in grass green, HbMet may be displayed in blue or light blue,HbCO may be displayed in orange, and SpaO₂ may be displayed in electricblue.

Moreover, parameter trend data may also be displayed using the same orsimilar color coding, especially when multiple trends are displayed onone or more display graphs. In addition, more coarse or gross parameterindications may be displayed for quick reference to indicate to acaregiver whether any of a variety of monitored parameters, such as, forexample, SpO₂, HbCO or HbMet is within acceptable ranges. The monitormay advantageously include additional display information, such as, forexample, parametric displays where one parameter is displayed as afunction of another, three dimensional displays (for example, extendinga parametric display along time or an additional parameter), directionalindicators predicting where a parameter is likely heading or reporting ageneral direction a parameters has been trending, or the like.

In addition to the foregoing, caregivers often desire to more closelymonitor parameters that are close to, approaching, or beyond normal safethresholds. In an embodiment, the patient monitor provides an indicationthat the caregiver should change display modes to view more criticalmonitored parameters. In alternative embodiments, the patient monitorautomatically changes display modes to show parameters moving closer toor beyond normal thresholds.

In an embodiment, the patient monitor includes an audible or visualindication of a type of sensor communicating with the monitor. Forexample, the monitor may determine how many wavelengths a particularattached sensor will emit through communication with memory devicesassociated with the attached sensor or cable.

Additional embodiments include audio or visual alarms for each ofmultiple monitored parameters, combinations of parameters, an indicationof perfusion in the tissue of the measurement site, an indication of theconfidence the signal processing has in its output measurements, or thelike.

For purposes of summarization, certain aspects, advantages and novelfeatures are described herein. Of course, it is to be understood thatnot necessarily all such aspects, advantages or features need to bepresent in any particular embodiment.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings and the associated descriptions are provided to illustrateembodiments of the disclosure and not to limit the scope of the claims.

FIG. 1 illustrates a block diagram of an exemplary embodiment of apatient monitoring system including a sensor and a multi-parameterpatient monitor.

FIG. 2 illustrates a top elevation view of an exemplary handheldnoninvasive multi-parameter patient monitor capable of displaying atleast HbCO, such as, for example, the patient monitor of FIG. 1.

FIG. 3 illustrates an exemplary display of the patient monitor of FIG.2.

FIG. 4 illustrates the display of FIG. 3 showing measured values ofSpO₂, BPM, perfusion, and type of sensor according to an exemplaryembodiment of the patient monitor of FIG. 1.

FIG. 5 illustrates the display of FIG. 3 showing measured values ofHbCO, perfusion, and type of sensor according to an exemplary embodimentof the patient monitor of FIG. 1.

FIG. 6 illustrates the display of FIG. 3 showing measured values ofSpO₂, HbCO, BPM, perfusion, and type of sensor, according to anexemplary embodiment of the patient monitor of FIG. 1.

FIG. 7 illustrates a top elevation view of an exemplary handheldnoninvasive multi-parameter patient monitor capable of displaying atleast HbCO and HbMet, such as, for example, the patient monitor of FIG.1.

FIG. 8 illustrates an exemplary display of the patient monitor of FIG.7.

FIG. 9 illustrates the display of FIG. 8 showing measured values ofSpO₂, BPM, HbCO, HbMet, and type of sensor according to an exemplaryembodiment of the patient monitor of FIG. 1.

FIG. 10 illustrates the display of FIG. 8 showing measured values ofHbCO, HbMet, and type of sensor according to an exemplary embodiment ofthe patient monitor of FIG. 1.

FIG. 11A illustrates a perspective view of an exemplary noninvasivemulti-parameter patient monitor such as, for example, the patientmonitor of FIG. 1.

FIGS. 11B-11H illustrate display screens of the patient monitor of FIG.11A.

DETAILED DESCRIPTION

Embodiments of the present disclosure include a portable or othermulti-parameter patient monitor capable of determining multiplephysiological parameters from one or more signals output from one ormore light sensitive detectors capable of detecting light attenuated bybody tissue carrying pulsing blood. For example, in an embodiment, themonitor advantageously and accurately determines a wide variety ofphysiological parameters or other calculations as discussed above.

In an embodiment, the display of patient monitor advantageously includesa plurality of display modes enabling more parameter data to bedisplayed than the available physical display real estate. For example,the patient monitor may include one or more user input keys capable oftoggling through measurement data. In an embodiment, the displaysinclude mode indicators providing caregivers easily identifiable visualqueues, such as LED's, text, icons, or other indicia providing readilyidentifiable queues as to which parameter is being displayed. In anembodiment, the display may shift, may be parameter color-coded, or thelike to further ensure quick comprehension of which measured parameteris the displayed parameter. For example, in an embodiment, the monitordisplays SpO₂ in white, pulse rate (BPM) in green, HbCO in orange, andHbMet in blue when the respective measured parameter is within a“normal” range.

In an embodiment, the patient monitor provides an indication that thecaregiver should change display modes to view more critical or timesensitive measured parameters, specific caregiver selected parameters,or the like. For example, the patient monitor may advantageously soundaudio or visual alarms that alert the caregiver to particular one ormore of worsening parameters, parameters changing in a predeterminedpattern or rate, parameters stabilizing below user defined or safethresholds, caregiver selected parameters, or the like. The monitor mayalso use alerts that provide audio or visual indications of the severityof the condition, severity of the change, or the like. In alternativeembodiments, the patient monitor may automatically change display modeswhen a particular parameter crosses one or more thresholds. For example,a patient monitor may be displaying a first parameter, such as aplethysmograph, and upon determining measurements indicating that HBMetis trending toward an alarm condition, the monitor may automaticallyswitch from displaying the first parameter to the alarming parameter, orin this case, a trend of the alarming parameter.

In an embodiment, a switch is provided to allow a user to switchdisplays to view an alarming measurement. In an embodiment, during analarm condition, a parameter display may switch to a trend graph in thesame or different color, line weight, flash, flash rate, intensity,size, or the like.

The patient monitor may also include one or more displays capable ofdisplaying trend data for any one or more of the monitored or derivedpatient parameters. For example, the trend data may be displayed ingraph form, may include multiple trend lines, each representing adifferent monitored or derived patient parameter. Moreover, each trendline may be color-coded to facilitate quick comprehension of which trendline represents which measured parameter. However, an artisan willrecognize from the disclosure herein a large number of identificationtechniques including color-coding, identifying text, or the like.Additionally, user input may toggle displayed trend data, may selectwhich parameters to display simultaneously, or the like.

In an embodiment, the patient monitor includes an audible or visualindication of a type of sensor communicating with the monitor. Forexample, the patient monitor may provide a particular audio or visualindication, such as a beep, LED activation, graphic activation, textmessages, voice messages, or the like, to indicate communication with orconnection to an approved sensor, patient cable, combination, or thelike. In an embodiment, the indication may change based on themanufacturer, type of sensor recognized or not recognized, type ofpatient, type of physiological parameters measurable with the attachedsensor, or the like. Additional embodiments include an indication ofperfusion in the tissue of the measurement site and an indication of theconfidence the signal processing has in its output measurements or inputsignal quality.

To facilitate an understanding of the disclosure, the remainder of thedescription references exemplary embodiments illustrated in thedrawings. Moreover, in this application, reference is made to many bloodparameters. Some references that have common shorthand designations arereferenced through such shorthand designations. For example, as usedherein, HbCO designates carboxyhemoglobin, HbMet designatesmethemoglobin, and Hbt designates total hemoglobin. Other shorthanddesignations such as COHb, MetHb, and tHb are also common in the art forthese same constituents. These constituents are generally reportedherein in terms of a percentage, often referred to as saturation,relative concentration or fractional saturation. Total hemoglobin isgenerally reported as a concentration in g/dL. The use of the particularshorthand designators presented in this application does not restrictthe term to any particular manner in which the designated constituent isreported.

FIG. 1 illustrates a block diagram of an exemplary embodiment of apatient monitoring system 100. As shown in FIG. 1, the system 100includes a patient monitor 102 comprising a processing board 104 and ahost instrument 108. The processing board 104 communicates with a sensor106 to receive one or more intensity signal(s) indicative of one or moreparameters of tissue of a patient. The processing board 104 alsocommunicates with a host instrument 108 to display determined valuescalculated using the one or more intensity signals. According to anembodiment, the processing board 104 comprises processing circuitryarranged on one or more printed circuit boards capable of installationinto the monitor 102, or capable of being distributed as some or all ofone or more OEM components for a wide variety of host instrumentsmonitoring a wide variety of patient information. In an embodiment, theprocessing board 104 comprises a sensor interface 110, a digital signalprocessor and signal extractor (“DSP” or “processor”) 112, and aninstrument manager 114. In general, the sensor interface 110 convertsdigital control signals into analog drive signals capable of drivingsensor emitters, and converts composite analog intensity signal(s) fromlight sensitive detectors into digital data.

In an embodiment, the sensor interface 110 manages communication withexternal computing devices. For example, in an embodiment, amultipurpose sensor port (or input/output port) is capable of connectingto the sensor 106 or alternatively connecting to a computing device,such as a personal computer, a PDA, additional monitoring equipment ornetworks, or the like. When connected to the computing device, theprocessing board 104 may upload various stored data for, for example,off-line analysis and diagnosis. The stored data may comprise trend datafor any one or more of the measured parameter data, plethysmographwaveform data acoustic sound waveform, or the like. Moreover, theprocessing board 104 may advantageously download from the computingdevice various upgrades or executable programs, may perform diagnosis onthe hardware or software of the monitor 102. In addition, the processingboard 104 may advantageously be used to view and examine patient data,including raw data, at or away from a monitoring site, through datauploads/downloads, or network connections, combinations, or the like,such as for customer support purposes including software maintenance,customer technical support, and the like. Upgradable sensor ports aredisclosed in copending U.S. application Ser. No. 10/898,680, filed onJul. 23, 2004, titled “Multipurpose Sensor Port,” incorporated byreference herein.

As shown in FIG. 1, the digital data is output to the DSP 112. Accordingto an embodiment, the DSP 112 comprises a processing device based on theSuper Harvard ARChitecture (“SHARC”), such as those commerciallyavailable from Analog Devices. However, a skilled artisan will recognizefrom the disclosure herein that the DSP 112 can comprise a wide varietyof data and/or signal processors capable of executing programs fordetermining physiological parameters from input data. In particular, theDSP 112 includes program instructions capable of receiving multiplechannels of data related to one or more intensity signals representativeof the absorption (from transmissive or reflective sensor systems) of aplurality of wavelengths of emitted light by body tissue. In anembodiment, the DSP 112 accepts data related to the absorption of eight(8) wavelengths of light, although an artisan will recognize from thedisclosure herein that the data can be related to the absorption of two(2) to sixteen (16) or more wavelengths.

FIG. 1 also shows the processing board 104 including the instrumentmanager 114. According to an embodiment, the instrument manager 114 maycomprise one or more microcontrollers controlling system management,including, for example, communications of calculated parameter data andthe like to the host instrument 108. The instrument manager 114 may alsoact as a watchdog circuit by, for example, monitoring the activity ofthe DSP 112 and resetting it when appropriate.

The sensor 106 may comprise a reusable clip-type sensor, a disposableadhesive-type sensor, a combination sensor having reusable anddisposable components, or the like. Moreover, an artisan will recognizefrom the disclosure herein that the sensor 106 can also comprisemechanical structures, adhesive or other tape structures, Velcro wrapsor combination structures specialized for the type of patient, type ofmonitoring, type of monitor, or the like. In an embodiment, the sensor106 provides data to the board 104 and vice versa through, for example,a patient cable. An artisan will also recognize from the disclosureherein that such communication can be wireless, over public or privatenetworks or computing systems or devices, or the like.

As shown in FIG. 1, the sensor 106 includes a plurality of emitters 116irradiating the body tissue 118 with differing wavelengths of light, andone or more detectors 120 capable of detecting the light afterattenuation by the tissue 118. In an embodiment, the emitters 116comprise a matrix of eight (8) emission devices mounted on a flexiblesubstrate, the emission devices being capable of emitting eight (8)differing wavelengths of light. In other embodiments, the emitters 116may comprise twelve (12) or sixteen (16) emitters, although othernumbers of emitters are contemplated, including two (2) or moreemitters. As shown in FIG. 1, the sensor 106 may include otherelectrical components such as, for example, a memory device 122comprising an EPROM, EEPROM, ROM, RAM, microcontroller, combinations ofthe same, or the like. In an embodiment, other sensor components mayinclude a temperature determination device 123 or other mechanisms for,for example, determining real-time emission wavelengths of the emitters116.

The memory 122 may advantageous store some or all of a wide variety dataand information, including, for example, information on the type oroperation of the sensor 106; type or identification of sensor buyer ordistributor or groups of buyer or distributors, sensor manufacturerinformation, sensor characteristics including the number of emittingdevices, the number of emission wavelengths, data relating to emissioncentroids, data relating to a change in emission characteristics basedon varying temperature, history of the sensor temperature, current, orvoltage, emitter specifications, emitter drive requirements,demodulation data, calculation mode data, the parameters for which thesensor is capable of supplying sufficient measurement data (e.g., HpCO,HpMet, HbT, or the like), calibration or parameter coefficient data,software such as scripts, executable code, or the like, sensorelectronic elements, whether the sensor is a disposable, reusable,multi-site, partially reusable, partially disposable sensor, whether itis an adhesive or non-adhesive sensor, whether the sensor is areflectance, transmittance, or transreflectance sensor, whether thesensor is a finger, hand, foot, forehead, or ear sensor, whether thesensor is a stereo sensor or a two-headed sensor, sensor life dataindicating whether some or all sensor components have expired and shouldbe replaced, encryption information, keys, indexes to keys or hashfunctions, or the like, monitor or algorithm upgrade instructions ordata, some or all of parameter equations, information about the patient,age, sex, medications, and other information that may be useful for theaccuracy or alarm settings and sensitivities, trend history, alarmhistory, or the like. In an embodiment, the monitor may advantageouslystore data on the memory device, including, for example, measuredtrending data for any number of parameters for any number of patients,or the like, sensor use or expiration calculations, sensor history, orthe like.

FIG. 1 also shows the patient monitor 102 including the host instrument108. In an embodiment, the host instrument 108 communicates with theboard 104 to receive signals indicative of the physiological parameterinformation calculated by the DSP 112. The host instrument 108preferably includes one or more display devices 124 capable ofdisplaying indicia representative of the calculated physiologicalparameters of the tissue 118 at the measurement site. In an embodiment,the host instrument 108 may advantageously comprise a handheld housingcapable of displaying one or more of a pulse rate, plethysmograph data,perfusion quality such as a perfusion quality index (“PI™”), signal ormeasurement quality (“SQ”), values of blood constituents in body tissue,including for example, SpO₂, HbCO, HbMet, Hbt, or the like. In otherembodiments, the host instrument 108 is capable of displaying values forone or more of Hbt, Hb, blood glucose, bilirubin, or the like. The hostinstrument 108 may be capable of storing or displaying historical ortrending data related to one or more of the measured values,combinations of the measured values, plethysmograph data, or the like.The host instrument 108 also includes an audio indicator 126 and userinput device 128, such as, for example, a keypad, touch screen, pointingdevice, voice recognition device, or the like.

In still additional embodiments, the host instrument 108 includes audioor visual alarms that alert caregivers that one or more physiologicalparameters are falling below predetermined safe thresholds. The hostinstrument 108 may include indications of the confidence a caregivershould have in the displayed data. In a further embodiment, the hostinstrument 108 may advantageously include circuitry capable ofdetermining the expiration or overuse of components of the sensor 106,including, for example, reusable elements, disposable elements, orcombinations of the same.

Although described in terms of certain embodiments, other embodiments orcombination of embodiments will be apparent to those of ordinary skillin the art from the disclosure herein. For example, the monitor 102 maycomprise one or more monitoring systems monitoring parameters, such as,for example, vital signs, blood pressure, ECG or EKG, respiration,glucose, bilirubin, or the like. Such systems may combine otherinformation with intensity-derived information to influence diagnosis ordevice operation. Moreover, the monitor 102 may advantageously includean audio system, preferably comprising a high quality audio processorand high quality speakers to provide for voiced alarms, messaging, orthe like. In an embodiment, the monitor 102 may advantageously includean audio out jack, conventional audio jacks, headphone jacks, or thelike, such that any of the display information disclosed herein may beaudiblized for a listener. For example, the monitor 102 may include anaudible transducer input (such as a microphone, piezoelectric sensor, orthe like) for collecting one or more of heart sounds, lung sounds,trachea sounds, or other body sounds and such sounds may be reproducedthrough the audio system and output from the monitor 102. Also, wired orwireless communications (such as Bluetooth or WiFi, including IEEE801.11a, b, or g), mobile communications, combinations of the same, orthe like, may be used to transmit the audio output to other audiotransducers separate from the monitor 102.

For example, patterns or changes in the continuous noninvasivemonitoring of intensity-derived information may cause the activation ofother vital sign measurement devices, such as, for example, bloodpressure cuffs.

FIG. 2 illustrates a perspective view of an exemplary handheldnoninvasive multi-parameter patient monitor 200, such as, for example,the patient monitor 102 of FIG. 1. Patient monitors 200 exhibitingcombinations of many of the features described herein are advantageouslycommercially available from Masimo under the brand name “Rad 57c.” Asshown in FIG. 2, the monitor 200 includes a patient cable connector 202capable of mechanical mating with a patient cable to establishcommunication between the processing board 104 and the sensor 106. In anembodiment, the connector 202 comprises a multipurpose cable connectorsuch as that disclosed in the incorporated U.S. application Ser. No.10/898,680, titled “Multipurpose Sensor Port,” disclosing communicationbetween the processing board 104 and an external computing device.

The monitor 202 also comprises a HbCO indicator 204 advantageouslyproviding a visual queue that a HbCO capable sensor is properlyconnected through the connector 202. For example, the HbCO indicator 204may advantageously activate when a sensor is connected that communicatessufficient information to determine HbCO, such as, for example, a sensorcapable of emitting sufficient different wavelengths of light, a sensorstoring sufficient data on the memory 122, a sensor having appropriateencryption data or key, combinations of the same, or the like. Forexample, in an embodiment, the processor 112 may receive informationfrom a memory 122 indicating a number of available LED wavelengths forthe attached sensor. Based on the number of wavelengths, or otherinformation stored on the memory 122, the processor 112 may determinewhether an HbCO-ready sensor has been attached to the monitor 200. Anartisan will also recognize from the disclosure herein that the HbCOindicator 204 may advantageously comprise a HbMet indicator, Hbtindicator, or the like, which activates to a predetermined colorassociated with a parameter, or any color, or deactivates the same, toconvey a type of attached sensor. Moreover, the artisan will recognizefrom the disclosure herein other parameters that may use other sensorcomponents and the monitor 200 may include indicators capable ofindicating communication with those types of sensors.

In an embodiment, the monitor 200 may also audibly indicate the type ofsensor connected. For example, the monitor 200 may emit predeterminednumber or frequency of beeps associated with recognition of a particularsensor, a particular manufacturer, failure to recognize the sensor, orthe like. Moreover, the sensor type may be indicative of thecomponentry, such as, for example, whether the sensor producessufficient data for the determination of HbCO, HbMet, Hbt and SpO₂, SpO₂only, SpO₂ and HbMet, any combination of the foregoing or otherparameters, or the like. Additionally, the sensor type may be indicativeof specific sensors designed for a type of patient, type of patienttissue, or the like. In other embodiments, the monitor 200 may announcethe type of connector through speaker 236.

An artisan will also recognize from the disclosure herein that othermechanical (such as keys), electrical, or combination devices may informthe monitor 202 of the type of attached sensor. In an embodiment, theprocessor 112 also may select to drive less emitters that are currentlyavailable, such as, for example, in the presence of low noise and whenpower consumption is an issue.

The monitor 202 also comprises a multi-mode display 206 capable ofdisplaying, for example, measurements of SpO₂ and HbCO (oralternatively, HbMet). In an embodiment, the display 206 hasinsufficient space or display real estate to display the many parameterscapable of being measured by the monitor 200. Thus, the multi-modedisplay 206 may advantageously cycle through two or more measuredparameters in an area common to both parameters even when shifted. Insuch embodiments, the monitor 200 may also advantageously includeparameter indicators 208, 210, providing additional visual queues as towhich parameter is currently displayed. In an embodiment, the displaymay also cycle colors, flash rates, or other audio or visual queuesproviding readily identifiable information as to which measuredparameter is displayed. For example, when the multi-mode display 206displays measured values of SpO₂ that are normal, the numbers mayadvantageously appear in green, while normal measured values of HbCO mayadvantageously appear in orange, and normal measured values of HbMet mayappear in blue. Moreover, in an embodiment, the display 206 flashes at apredefined rate when searching for saturation and at another predefinedrate when a signal quality is below a predetermined threshold.

The monitor 202 also comprises a HbCO bar 212 where in an embodiment aplurality of LED's activate from a bottom toward a top such that the bar“fills” to a level proportional to the measured value. For example, thebar 212 is lowest when the dangers from carbon monoxide poisoning arethe least, and highest when the dangers are the greatest. The bar 212includes indicia 214 that provide an indication of the severity ofcarbon monoxide saturation in a patient's blood. As shown in FIG. 2, thebar 212 and the indicia 214 continuously indicate the concentration ofHbCO in about 5% increments. The indicia 214 indicate a measurement ofHbCO saturation percentage between about 0 and about 50% with agranularity of about 5%. However, an artisan will also recognize fromthe disclosure herein a wide variety of ranges and granularities couldbe used, the indicia 214 could be electronically displayed in order tostraightforwardly increase or decrease resolution, or the like. Forexample, HbCO may advantageously be displayed with greater resolutionthan ± about %5 in a lower portion of the scale. For example, an HbCObar may advantageously include a scale of about <3%, about 6%, about 9%,about 12%, about 15%, about 20%, about 25%, about 30%, about 35%, andabout >40%.

As is known in the art, carbon monoxide in the blood can lead to seriousmedical issues. For example and depending upon the particular physiologyof a patient, about 10% carbon monoxide saturation can lead toheadaches, about 20% can lead to throbbing headaches, or dyspnea onexertion, about 30% can lead to impaired judgment, nausea, dizzinessand/or vomiting, visual disturbance, or fatigue, about 40% can lead toconfusion and syncope, and about 50% and above can lead to comas,seizures, respiratory failure and even death.

In an embodiment, the bar 212 is the same or similar color as themulti-mode display 206 when displaying HbCO. In other embodiments, thebar 212 is lowest and green when the dangers from carbon monoxidepoisoning are the least, and highest and red when the dangers are thegreatest. In an embodiment, as HbCO increases, the entire bar 212 mayadvantageously change color, such as, for example, from green to red, toprovide a clear indication of deepening severity of the condition. Inother embodiments, the bar 212 may advantageously blink or flash, anaudio alarm may beep or provide a continuation or rise in pitch orvolume, or the like to alert a caregiver of deepening severity.Moreover, straightforward to complex alarm rules may be implemented toreduce false alarms based on, for example, knowledge of thephysiological limitations on the rate of change in HbCO or the like.

Additionally, the monitor 200 may be capable of storing and outputtinghistorical parameter data, display trend traces or data, or the like.Although the foregoing bar 212 has been described in terms of certainpreferred embodiments, other embodiments will be apparent to those ofordinary skill in the art from the disclosure herein.

FIG. 2 also shows the monitor 200 including a pulse display 216displaying measured pulse rate in beats per minute (“BPM”). In anembodiment, the display 212 flashes when searching for a pulse. Thepulse display 216 advantageously displays measured pulse rates fromabout zero (0) to about two hundred and forty (240) BPM. Moreover, whenthe measured pulse rates are considered normal, the pulse display 216 isadvantageously green. Similar to other displays associated with themonitor 200, the pulse display 216 may employ a variety of colorchanges, audio alarms, or combinations of the same to indicate measuredBPM below predetermined safe thresholds. In an embodiment, the pulserate display 216 displays the measured pulse rate during the display ofSpO₂ and displays message data during the display of other parameters.For example, during the display of HbCO, the display 216 mayadvantageously display the term “CO.” In an embodiment, the display ofthe message data may be in the same or similar color as the otherdisplays. For example, in an embodiment, the multi-mode display 206, thebar 212, and the pulse display 216 may all display data or messages inorange when the multi-mode display 206 displays measured HbCO values.

FIG. 2 also illustrates the monitor 200 comprising user input keys 218,including a HbCO button 220, mode/enter button 222, next button 224,power on/off button 226, up/down button 228, and alarm silence button230. In an embodiment, activation of the HbCO button 220 toggles themeasured value displayed in the multi-mode display 206. For example,activation of the HbCO button 220 toggles the multi-mode display 206from displaying measured values of SpO₂ to HbCO for about ten (10)seconds. Activation of the mode/enter button 222 or the next button 224during the ten (10) second period returns the multi-mode display 206back to SpO₂. A skilled artisan will also recognize that activation ofthe HbCO button 220 may advantageously toggle through a plurality ofmeasured values, and that such values may be displayed for shortsegments and then return to SpO₂, may remain displayed until furtheractivation of the button 220, or the like.

Activation of the mode/enter button 222 cycles through various setupmenus allowing a caregiver to select or activate certain entries withinthe menu setup system, including alarm threshold customizations, or thelike. Activation of the next button 224 can move through setup optionswithin the menu setup system and in an embodiment is not active duringnormal patient monitoring. For example, a caregiver may activate themode/enter button 222 and the next button 224 to specify high and lowalarm thresholds for one or more of the measured parameters, to specifydevice sensitivity, trend settings, display customizations, color codeparameters, or the like. In an embodiment, the high alarm setting forSpO₂ can range from about two percent (2%) to about one hundred percent(100%) with a granularity of about one percent (1%). The low alarmsetting for SpO₂ can range from about one percent (1%) to about onehundred percent (100%) with a granularity of about one percent (1%).Moreover, the high alarm setting for pulse rate can range from aboutthirty (30) BPM to about two hundred and forty (240) BPM with agranularity of about five (5) BPM. The low alarm setting for pulse ratecan range from about twenty five (25) BPM to about two hundred andthirty five (235) BPM with a granularity of about five (5) BPM. Otherhigh and low ranges for other measured parameters will be apparent toone of ordinary skill in the art from the disclosure herein.

In a further embodiment, a caregiver may activate the mode/enter button222 and the next button 224 to specify device sensitivity, such as, forexample, device averaging times, probe off detection, whether to enablefast saturation calculations, or the like. Various embodiments of fastsaturation calculations are disclosed in U.S. patent application Ser.No. 10/213,270, filed Aug. 5, 2002, titled “Variable IndicationEstimator” and incorporated by reference herein. Using the menus, acaregiver may also advantageously enter appropriate informationgoverning trend collection on one or more of the measured parameters,input signals, or the like.

FIG. 2 also shows the power on/off button 226. Activation of the poweron/off button 226 activates and deactivates the monitor 200. In anembodiment, press-and-hold activation for about two (2) seconds shutsthe monitor 200 off. In an additional embodiment, activation of theon/off button 226 advantageously initiates detection of a type ofattached sensor. For example, activation of the on/off button 226 mayadvantageously cause the monitor 200 to read information from a memoryon an attached sensor and determine whether sufficient wavelengths existon the sensor to determine one or more the physiological parametersdiscussed in the foregoing.

An artisan will recognize from the disclosure herein that the on/offbutton 226 may advantageously cause an electronic determination ofwhether to operate in at powers consisted with the U.S. (60 Hz) oranother nationality (50 Hz). In an embodiment, such automaticdetermination and switching is removed from the monitor 200 in order toreduce a likelihood of problematic interfering crosstalk caused by suchpower switching devices.

Activation of the up/down button 228 may advantageously adjust thevolume of the pulse beep tone. Additionally, activation of the up/downbutton 228 within the menu setup system, causes the selection of valueswith various menu options.

Moreover, activation of the alarm silence button 230 temporarilysilences audio alarms for a predetermined period, such as, for example,about one hundred and twenty (120) seconds. A second activation of thealarm silence button 230 mutes (suspends) the alarm indefinitely, whilea third activation returns the monitor 200 to standard alarm monitoring.FIG. 2 also shows the alarm silence button 230 includes an alarmsilenced indicator 232. The alarm silenced indicator 232 mayadvantageously flash to indicate one or more alarms are temporarilysilenced, may illuminate solid to indicate the alarms have been muted,or the like. Moreover, an artisan will recognize from the disclosureherein a wide variety of alarm silencing methodologies.

The monitor 202 also includes a battery level indicator 234 indicatingremaining battery life. In the illustrated embodiment, four LED'sindicate the status of the battery by incrementally deactivating toindicate proportionally decreasing battery life. In an embodiment, thefour LED's may also change color as the battery charge decreases, andthe final LED may begin to flash to indicate that the caregiver shouldreplace the batteries.

FIG. 2 also shows the monitor 202 including an audio transducer orspeaker 236. The speaker 236 advantageously provides audible indicationsof alarm conditions, pulse tone and feedback for key-presses, or thelike. Moreover, the monitor 202 includes a low signal quality indicator(“SQ” or “SIQ™”) 238. The signal IQ indicator 238 activates to inform acaregiver that a measured value of the quality of the incoming signal isbelow predetermined threshold values. For example, in an embodiment, themeasured value for signal IQ is at least partially based on anevaluation of the plethysmograph data's correspondence to predeterminedmodels or characteristics of physiological signals. In an embodiment,the signal IQ indicator 238 output may be associated with the displayedparameter. For example, the output may be associated with one thresholdfor the display of SpO₂ and another for the display of other parameterdata.

The monitor 202 also comprises a perfusion quality index (“PI™”) bar 240(which quantifies the measure of perfusion of the patient) where in anembodiment a plurality of LED's activate from a bottom toward a top suchthat the bar “fills” to a level proportional to the measured value. Inone embodiment, the PI™ bar 240 shows a static value of perfusion for agiven time period, such as, for example, one or more pulses. In anotherembodiment, or functional setting, the PI™ bar 240 may advantageouslypulse with a pulse rate, may hold the last reading and optionally fadeuntil the next reading, may indicate historical readings through colorsor fades, or the like. Additionally, the PI™ bar 240 may advantageouslychange colors, flash, increasingly flash, or the like to indicateworsening measured values of perfusion.

The PI™ bar 240 can be used to simply indicate inappropriate occlusiondue, for example, to improper attachment of the sensor 106. The PI™ bar240 can also be used as a diagnostic tool during low perfusion for theaccurate prediction of illness severity, especially in neonates.Moreover, the rate of change in the PI™ bar 240 can be indicative ofblood loss, sleep arousal, sever hypertension, pain management, thepresence or absence of drugs, or the like. According to one embodiment,the PI™ bar 240 values may comprise a measurement of the signal strengthof the arterial pulse as a percentage of the total signal received. Forexample, in one preferred embodiment, the alternating portion of atleast one intensity signal from the sensor 106 may advantageously bedivided by the static portion of the signal. For example, an infraredintensity signal may advantageously be used as it is less subjective tonoise.

In an embodiment, a measurement below about 1.25% may indicate medicalsituations in need of caregiver attention, specifically in monitoredneonates. Because of the relevance of about 1.25%, the PI™ bar 240 mayadvantageously include level indicia 242 where the indicia 242 swapsides of the PI™ bar 240, thus highlighting any readings below aboutthat threshold. Moreover, behavior of the PI™ bar 240, as discussedabove, may advantageously draw attention to monitored values below sucha threshold.

As discussed above, the monitor 200 may include output functionalitythat outputs, for example, trend perfusion data, such that a caregivercan monitor measured values of perfusion over time. Alternatively oradditionally, the monitor 200 may display historical trace data on anappropriate display indicating the measured values of perfusion overtime. In an embodiment, the trend data is uploaded to an externalcomputing device through, for example, the multipurpose sensor connector202 or other input output systems such as USB, serial or parallel portsor the like.

The monitor 200 also includes an alarm indicator 244 capable ofproviding visual queues of the status of one or more of the measuredparameters. For example, the alarm indicator 244 may advantageously begreen when all of the measured parameters are within normal conditions,may gradually fade to red, may flash, increasing flash, or the like, asone or more of the measured values approaches or passes predeterminedthresholds. In an embodiment, the alarm indicator 244 activates when anyparameter falls below an associated threshold, thereby advantageouslyinforming a caregiver that perhaps a nondisplayed parameters is at analarm condition. In another embodiment, the alarm indicator 244 mayindicate the status of the parameter displayed on the multi-mode display206. In an embodiment, the speaker 236 may sound in conjunction withand/or in addition to the indicator 244. Moreover, in an embodiment, analarming parameter may automatically be displayed, may be emphasized,flashed, colored, combinations of the same or the like to draw a user'sattention to the alarming parameter.

Although the foregoing invention has been described in terms of certainpreferred embodiments, other embodiments will be apparent to those ofordinary skill in the art from the disclosure herein.

FIG. 3 illustrates an exemplary display of the patient monitor 200. Asshown in FIG. 3, the display includes the multi-mode display 206, thepulse rate display 216, parameter indicators 208, 210, the HbCO bar 212and indicator 204, the PI™ bar 240, and the alarm indicator 244. In anembodiment, the multi-mode display 206 and the pulse rate display 216each comprise a plurality of seven segment displays 302 capable ofdisplaying alpha-numeric information. As disclosed in the foregoing, theexemplary display may advantageously include color-coded parameterdisplays. Moreover, the exemplary display may include colorprogressions, flashing, flashing progressions, audible alarms, audibleprogressions, or the like, indicating worsening measured values ofphysiological data. In addition, in an embodiment, some or all of thedisplays may flash at a first rate to indicate attempts to acquire datawhen actual measured values are unavailable. Moreover, some or all ofthe display may flash at a second rate to indicate low signal qualitywhere confidence is decreasing that the measured values reflect actualphysiological conditions.

FIG. 4 illustrates the display of FIG. 3 showing measured values ofSpO₂, BPM, perfusion, and type of sensor, according to an exemplaryembodiment of the patient monitor of FIG. 1. As shown in FIG. 4, themulti-mode display 206 is displaying a percentage value of SpO₂, and thepulse rate display 216 is displaying a pulse rate in beats per minute.Accordingly, the parameter indicator 210 is activated to confirm thedisplay of measured values of SpO₂. As disclosed in the foregoing, in anembodiment, the multi-mode display 206 is red, indicating blood oxygenmeasurements while the pulse rate display 216 is green, indicatingnormal values of a patient's pulse.

FIG. 4 also shows the PI™ bar 240 almost fully activated, representinggood perfusion. In addition, the HbCO indicator 204 is showingcommunication with a sensor producing insufficient data to determinemeasured values of additional parameters, such as, HbCO. In anembodiment, such sensors may comprise sensors capable of emitting lightat about two (2) different wavelengths, may comprise sensors withinsufficient data stored on a memory associated therewith, or the like.

FIG. 5 illustrates the display of FIG. 3 showing measured values ofHbCO, perfusion, and type of sensor, according to an exemplaryembodiment of the patient monitor of FIG. 1. As shown in FIG. 5, themulti-mode display 206 is displaying a percentage value of HbCO, and thepulse rate display 216 is displaying an appropriate message indicatingthe HbCO measurement, such as, for example, “CO”. Also, the multi-modedisplay 206 has shifted the data to the left to quickly and efficientlyindicate that the displayed parameter is other than SpO₂. Accordingly,the parameter indicator 208 is also activated to confirm the display ofmeasured values of HbCO. As disclosed in the foregoing, in anembodiment, the multi-mode display 206 and pulse rate display message216 are orange.

FIG. 5 also shows the PI™ bar 240 almost fully activated, representinggood perfusion. In addition, the activation of the HbCO indicator 204represents communication with a sensor capable of producing sufficientdata to determine measured values of HbCO. In an embodiment, suchsensors may comprise sensors capable of emitting light at about eight(8) or more different wavelengths; however, such sensors may compriseabout two (2) or more different wavelengths. Moreover, such sensors mayhave appropriate data stored on a memory associated therewith, or thelike. FIG. 5 also shows the HbCO measurement being about 20% (asillustrated on the HbCO bar 212 and multi-mode display 206) therebyindicating a potentially dangerous situation that if exacerbated, willbecome quite problematic. Therefore, the alarm indicator 244 is alsoactivated, and in some embodiments, the speaker 236 as well.

FIG. 6 illustrates the display of FIG. 3 showing measured values ofSpO₂, HbCO, BPM, perfusion, and type of sensor, according to anexemplary embodiment of the patient monitor of FIG. 1. In contrast toFIG. 4, FIG. 6 shows that the monitor 200 is communicating with a sensorcapable of producing sufficient data to determine measured values ofHbCO, even though the displayed values are that of SpO₂ and BPM. Thus,FIG. 6 shows the activation of the HbCO indicator 204, and thecontinuous monitoring of HbCO by the HbCO bar 212. FIG. 6 also shows ahigh value of HbCO, and therefore, the indication of an alarm conditionby activation of the alarm indicator 244. In an embodiment, upondetermination of an alarm condition on a nondisplayed parameter, themonitor 200 may advantageously provide an alarm indication throughspeaker and alarm indicator activation, automatic toggle to thenondisplayed parameter on the multi-mode display 206 for a defined orundefined time, or the like.

FIG. 7 illustrates a top elevation view of an exemplary handheldnoninvasive multi-parameter patient monitor 700 capable of displaying atleast HbCO and HbMet, such as, for example, the patient monitor ofFIG. 1. Patient monitors exhibiting combinations of many of the featuresdescribed herein are advantageously commercially available from Masimounder the brand name “Rad 57 cm.” As shown in FIG. 7, the monitor 700comprises a monitor similar to monitor 200 disclosed with reference toFIG. 2. Moreover, monitor 700 further includes a multi-mode display 706capable of displaying, for example, measurements of HbMet and BPM. In anembodiment, the display 706 has insufficient space or display realestate to display the many parameters capable of being measured by themonitor 700. Thus, the multi-mode display 706 may advantageously cyclethrough two or more measured parameters. In such embodiments, themonitor 700 may also advantageously include parameter indicators 708,710, providing additional visual queues as to which parameter iscurrently displayed. In an embodiment, the display 706 may also cyclecolors, flash rates, or other audio or visual queues providing readilyidentifiable information as to which measured parameter is displayed.For example, when the multi-mode display 706 displays measured values ofBPM that are normal, the numbers may advantageously appear in green,while normal measured values of HbMet may appear in blue. Moreover, inan embodiment, the display 706 may flash at a predefined rate whensearching for saturation and at another predefined rate when a signalquality is below a predetermined threshold.

FIG. 7 also illustrates the monitor 700 comprising user input keys 718,including an HbCO/HbMet button 220. In an embodiment, activation of theHbCO/HbMet button 720 toggles the measured value displayed in themulti-mode display 706. For example, activation of the HbCO/HbMet button720 toggles the multi-mode display 206 from displaying measured valuesof SpO₂ and BPM, to HbCO and HbMet for about ten (10) seconds.Activation of the mode/enter button 222 or the next button 224 duringthe ten (10) second period returns the multi-mode display 706 back toSpO₂ and BPM. A skilled artisan will also recognize that activation ofthe HbCO/HbMet button 720 may advantageously toggle through a pluralityof measured values, and that such values may be displayed for shortsegments and then return to SpO₂ and BPM, may remain displayed untilfurther activation of the button 720, or the like.

The monitor 700 also comprises a coarser indication of HbMet through anHbMet bar 740. In an embodiment, a plurality of LED's activate from abottom toward a top such that the bar “fills” to a level proportional tothe measured value, with increments at about 0.5%, about 1%, about 2%,about 3%, about 4%, about 5%, about 7.5%, about 10%, about 15% andgreater than about 20%, although an artisan will recognize from thedisclosure herein other useful delineations. Additionally, the HbMet bar740 may advantageously change colors, flash, increasingly flash, or thelike to indicate worsening measured values of perfusion.

Although disclosed with reference to the HbMet bar 740, and artisan willrecognize from the disclosure herein other coarse or even grossindications of HbMet, or any measured parameter. For example, a singleLED may advantageously show green, yellow, and red, to indicateworsening coarse values of HbMet. Alternatively, a single LED may simplylight to indicate an alarm or approaching alarm condition.

FIG. 8 illustrates an exemplary display of the patient monitor 700 ofFIG. 7. As shown in FIG. 8, the display includes the multi-mode displays206, 706, parameter indicators 208, 210, 708, 710, the HbCO bar 212 andindicator 204, the HbMet bar 740, and the alarm indicator 244. In anembodiment, the multi-mode display 706 is similar to multi-mode display206, comprising a plurality of seven segment displays 302 capable ofdisplaying alpha-numeric information, and capable of altering itsdisplay characteristics or aspects in a wide variety of configurationsdiscussed with reference to the display 206.

FIG. 9 illustrates the display of FIG. 8 showing measured values ofSpO₂, BPM, HbCO, HbMet, and type of sensor according to an exemplaryembodiment of the patient monitor of FIG. 1. FIG. 9 also shows the HbMetbar 740 near the bottom and corresponding to about 1%, representingacceptable HbMet, while the HbCO bar 212 hovers at a dangerous near 20%.In addition, the HbCO indicator 204 is showing communication with asensor producing sufficient data to determine measured values ofadditional parameters, such as, HbMet, HbCO or the like. In anembodiment, such sensors may comprise sensors capable of emitting lightof more than two (2) different wavelengths, preferably more than four(4) different wavelengths, and more preferably eight (8) or moredifferent wavelengths.

FIG. 10 illustrates the display of FIG. 8 showing measured values ofHbCO, HbMet, and type of sensor according to an exemplary embodiment ofthe patient monitor of FIG. 1. As shown in FIG. 10, the multi-modedisplay 706 is displaying a percentage value of HbMet that is shiftedusing the parameter indicator 708. The data has been advantageouslyshifted to the left to quickly and efficiently indicate that thedisplayed parameter is other than BPM. Accordingly, the parameterindicator 708 is also activated to confirm the display of measuredvalues of HbMet. As disclosed in the foregoing, in an embodiment, themulti-mode display 706 is blue.

FIG. 10 also shows the HbMet bar 740 nearly empty, representingacceptable HbMet. In addition, the activation of the HbCO indicator 204represents communication with a sensor capable of producing sufficientdata to determine measured values of HbCO. In an embodiment, suchsensors may have appropriate data stored on a memory associatedtherewith, or the like. FIG. 10 also shows the HbCO measurement beingabout 20% (as illustrated on the HbCO bar 212 and multi-mode display206) thereby indicating a potentially dangerous situation that ifexacerbated, will become quite problematic. Therefore, the alarmindicator 244 is also activated, and in some embodiments, the speaker236 as well.

FIG. 11A illustrates a perspective view of an exemplary noninvasivemulti-parameter patient monitor 1100, such as, for example, the patientmonitor of FIG. 1. Moreover, FIGS. 11B-11E illustrate exemplary displayscreens of the patient monitor of FIG. 11A. As shown in FIGS. 11A-11B,an embodiment of the monitor 1100 includes a display 1101 showing aplurality of parameter data. For example, the display may advantageouslycomprise a CRT or an LCD display including circuitry similar to thatavailable on oximeters commercially available from Masimo Corporation ofIrvine, Calif. sold under the name Radical™, and disclosed in the U.S.patents referenced above and incorporated above. However, an artisanwill recognize from the disclosure herein many commercially availabledisplay components capable of displaying multiple parameter data alongwith the ability to display graphical data such as plethysmographs,trend traces, and the like.

In an embodiment, the display includes a measured value of SpO₂ 1102, ameasured value of pulse rate 1104 in BPM, a plethysmograph 1106, ameasured value of HbCO 1108, a measured value of HbMet 1110, a measuredvalue of a perfusion quality 1112, a measured value of Hbt 1114, and aderived value of fractional saturation “SpaO₂” 1116. In an embodiment,SpaO₂ comprises HbO₂ expressed as a percentage of the four mainhemoglobin species, i.e., HbO₂, Hb, HbCO, and HbMet.

In an embodiment, one or more of the foregoing parameter includestrending or prediction indicators 1118 showing the current trend orprediction for that corresponding parameter. In an embodiment, theindicators 1118 may advantageously comprise an up arrow, a down arrow,and a hyphen bar to indicate up trending/prediction, downtrending/prediction, or neutral trending/prediction.

FIG. 11C illustrates an exemplary display screen showing trend graph1140 including trend line 1142 for HbMet. In an embodiment, the trendline 1142 may be advantageously colored for quick straightforwardrecognition of the trending parameter, may be associated with any one ormore of the foregoing alarm attributes, may include trending lines forother parameters, or the like. The display screen also shows trendingdirectional indicators 1142, 1144 for many of the displayedphysiological parameters. In an embodiment, the directional indicators1142, 1144 may advantageously comprises arrows showing the recent trend,predicted trend, user-customizable trend, combinations thereof, or thelike for the associated parameters. In an embodiment, the directionalindicators 1142, 1144 comprises an up arrow indicating a risingtrend/predicted trend, a middle bar indicating a somewhat stabletrend/predicted trend, and a down arrow indicating a loweringtrend/predicted trend. An artisan will recognize a wide variety of otherdirectional indicators 1142, 1144 from the disclosure herein.

FIG. 11D shows an exemplary display screen in vertical format. Suchvertical format could be user actuated or based on a gravity switch.FIGS. 11E-11F illustrate additional displays of various physiologicalparameters similar to those discussed in the foregoing. As shown in FIG.11G, the display includes a measured value of SpO₂ 1162, a measuredvalue of pulse rate 1164 in BPM, a plethysmograph 1166, a HbCO bar 1168,and a HbMet bar 1170. In an embodiment, the HbCO bar 1168 and HbMet bar1170 may advantageously behave the same or similarly to the HbCO bar 212and HbMet bar 712. Moreover, similar bars may advantageously display anyof the physiological parameters discussed herein using display indiciaappropriate to that parameter. For example, a SpO₂ or SpaO₂ bar mayadvantageously range from about 0% to about 100%, and more preferablyrange from about 50% to about 100%, while a Hbt bar may advantageouslyrange from about 0 to about 30.

Moreover, similar to the disclosure above, the measured value of SpO₂1162 may advantageously toggle to measured values of HbCO, HbMet, Hbt,or the like based on, for example, actuation of user input keys, or thelike.

In addition to the foregoing, the display may also include graphicaldata showing one or more color-coded or other identifying indicia fortraces of trend data. Moreover, other graphical presentations mayadvantageously provide readily identifiable indications of monitoredparameters or combinations of monitored parameters of the patient. Forexample, in an embodiment, the display includes a SpaO₂ graph 1172. TheSpaO₂ graph 1172 plots SpO₂ as a function of other blood analytes(1-SpaO₂), where SpaO₂ comprises HbO₂ expressed as a percentage of thefour main hemoglobin species, i.e., HbO₂, Hb, HbCO, and HbMet. Thus, asshown in FIG. 11G, as the slope of the displayed line or arrowincreases, the caregiver can readily note that the majority ofhemoglobin carriers are being used to carry oxygen, and not, forexample, harmful carbon monoxide. On the other hand, as the slopedecreases, the caregiver can readily and advantageously note that thenumber of hemoglobin species available to carry oxygen is decreasing,regardless of the current value of SpO₂. Moreover, the length of thearrow or line also provides an indication of wellness, e.g., the higherthe line the more oxygen saturation, the lower the line, the more likelythere may be desaturation event, or the like.

Thus, the SpaO₂ graph 1172 provides the caregiver with the ability torecognize that even though the measured value of SpO₂ may be withinacceptable ranges, there are potentially an unacceptable number ofhemoglobin carriers unavailable for carrying oxygen, and that otherpotential problems may exist, such as, for example, harmful carbonmonoxide levels, or the like. In an embodiment, various alarm conditionsmay cause the graph 1172 to change color, flash, or any combination ofalarm indications discussed in the forgoing. Moreover, FIG. 11Hillustrates yet an additional display of the foregoing parameters.

An embodiment may also include the monitor 1100 advantageously definingregions of wellness/severity of the monitored patient. For example,because the graph 1172 comprises two dimensions, the monitor 1100 mayadvantageously define regions where the patient's measured physiologicalparameters are considered acceptable, regions where the patient isconsidered at risk, regions where the patient is critical, and the like.For example, one region of acceptability may include a high SpO₂ and alow 1-SpaO₂, another region of risk may include a high SpO₂ and a high1-SpaO₂, and another critical region may include a low SpO₂ and a high1-SpaO₂. Moreover, an artisan will recognize from the disclosure hereinthat different parameters may also be combined to provide readilyidentifiable indications of patient wellness.

In addition to or as an alternative to the two dimensional SpaO₂ graph1172, the monitor 1100 may also include a three dimensional graph, suchas, for example, extending the graph 1172 along the variable of time. Inthis embodiment, the forgoing regions advantageously become threedimensional surfaces of wellness. Moreover, trend data may also beadvantageously added to the surface to provide a history of whenparticular monitored parameters dipped in and out of various surfaces ofwellness, risk, criticality, or the like. Such trend data could becolor-coded, text identified, or the like. An artisan will alsorecognize that such surfaces may be dynamic. For example, measurementsof HbCO> about 5 may dictate that trend data showing SpO₂< about 90%should be considered critical; however, measurements of HbCO< about 5may dictate only SpO₂< about 85% would be critical. Again, an artisanwill recognize from the disclosure herein other parameter combinationsto create a wide variety of wellness/critical regions or surfaces thatprovide readily available visual or audio indications of patient wellbeing, trigger specific alarms, or the like.

Moreover, the monitor 1100 may advantageously employ enlargement orreorganization of parameter data based on, for example, the severity ofthe measurement. For example, the monitor 1100 may display values forHbCO in a small portion of the screen or in the background, and whenHbCO begins to approach abnormal levels, the small portion mayadvantageously grown as severity increases, even in some embodiments todominate the display. Such visual alarming can be combined with audioalarms such as announcements, alarms, rising frequencies, or the like,and other visual alarms such as flashing, coloration, or the like toassist a caregiver in noticing the increasing severity of a monitoredparameter. In an embodiment, a location of the display of an alarmingvalue is changed to be displayed in a larger display area, such as 1102,so as to be readily noticeable and its display values readilyascertainable.

Although the foregoing invention has been described in terms of certainpreferred embodiments, other embodiments will be apparent to those ofordinary skill in the art from the disclosure herein. For example, themonitor 100 may advantageously be adapted to monitor or be included in amonitor capable of measuring physiological parameters other than thosedetermined through absorption spectroscopy, such as, for example, bloodpressure, ECG, EKG, respiratory rates, volumes, inputs for bloodpressure sensors, acoustical sensors, and the like. Moreover, themonitor 100 may be adapted for wireless communication to and from thesensor 106, and/or to and from other monitoring devices, such as, forexample, multi-parameter or legacy monitoring devices.

Also, other combinations, omissions, substitutions and modificationswill be apparent to the skilled artisan in view of the disclosureherein. Accordingly, the present invention is not intended to be limitedby the reaction of the preferred embodiments, but is to be defined byreference to the appended claims.

Additionally, all publications, patents, and patent applicationsmentioned in this specification are herein incorporated by reference tothe same extent as if each individual publication, patent, or patentapplication was specifically and individually indicated to beincorporated by reference.

What is claimed is:
 1. A method comprising: processing one or moresignals with one or more signal processors, said signals responsive toattenuation of light by body tissue of a monitored patient;noninvasively, electronically determining measured values of oxygensaturation and arterial carbon monoxide saturation, based at least inpart on the processed one or more signals; providing an alarm thresholdfor the oxygen saturation; altering the alarm threshold for the oxygensaturation based at least in part on at least one measured value of thearterial carbon monoxide saturation satisfying a threshold value; andactivating a caregiver alert based at least in part on at least onemeasured value of the oxygen saturation satisfying the altered alarmthreshold.
 2. The method of claim 1, wherein the caregiver alertcomprises at least one of an LED activation, an alarm message, and anaudible alarm.
 3. The method of claim 1, wherein the caregiver alertchanges as measured values of the oxygen saturation move further fromthe altered alarm threshold.
 4. The method of claim 1, whereinactivating the caregiver alert comprises emphasizing on a display themeasured values of the oxygen saturation.
 5. The method of claim 1,wherein activating the caregiver alert further comprises at least one ofaltering a size of measured values of the oxygen saturation on a displayand alternately displaying and removing from the display the measuredvalues of the oxygen saturation.
 6. The method of claim 1, furthercomprising: displaying on a display the at least one measured value ofthe oxygen saturation and; displaying on the display a predictionindicator corresponding to the oxygen saturation, wherein the predictionindicator indicates a predicted trend of measured values of the oxygensaturation.
 7. A patient monitor, comprising: a sensor port configuredto receive one or more signals from a sensor, wherein the signals areresponsive to attenuation of light by body tissue of a monitoredpatient; and a processor in communication with the sensor port andconfigured to: noninvasively, electronically determine measured valuesof a first blood constituent and a second blood constituent using theone or more signals received from the sensor, provide an alarm thresholdfor the first blood constituent, alter the alarm threshold for the firstblood constituent based at least in part on at least one measured valueof the second blood constituent satisfying a threshold value, andactivate a caregiver alert based at least in part on at least onemeasured value of the first blood constituent satisfying the alteredalarm threshold.
 8. The patient monitor of claim 7, wherein thecaregiver alert comprises an LED activation on a display device.
 9. Thepatient monitor of claim 7, wherein the caregiver alert comprises atleast one of an alarm message and an audible alarm.
 10. The patientmonitor of claim 7, wherein the caregiver alert comprises emphasizing ona display measured values of the first blood constituent.
 11. Thepatient monitor of claim 7, wherein the caregiver alert comprises atleast one of altering a size of measured values of the first bloodconstituent on a display and alternately displaying and removing fromthe display the measured values of the first blood constituent.
 12. Thepatient monitor of claim 7, wherein the processor is further configuredto cause a display to display thereon: the at least one measured valueof the first blood constituent, and a prediction indicator correspondingto the first blood constituent, wherein the prediction indicatorindicates a predicted trend of measured values of the first bloodconstituent.
 13. The patient monitor of claim 7, wherein the processoris further configured to cause a display in communication with theprocessor to display thereon a wellness qualitative indicationindicative of a patient wellness level based at least in part on acombination of the measured values of the first blood constituent andthe second blood constituent.
 14. A method comprising: noninvasively,electronically determining measured values of a plurality of bloodconstituent including at least a first blood constituent and a secondblood constituent, wherein the determining is performed by processingone or more signals with one or more signal processors, said signalsresponsive to attenuation of light by body tissue of a monitoredpatient; providing an alarm threshold for the first blood constituent;altering the alarm threshold for the first blood constituent based atleast in part on at least one measured value of the second bloodconstituent satisfying a threshold value; and activating a caregiveralert upon an occurrence of a predetermined event, wherein thepredetermined event is based at least in part on at least one measuredvalue of the first blood constituent satisfying the altered alarmthreshold.
 15. The method of claim 14, wherein the plurality of bloodconstituent comprise at least one of carb oxyhemoglobin, methemoglobin,hemoglobin, oxygen saturation, and fractional saturation.
 16. The methodof claim 14, wherein the caregiver alert comprises at least one of anLED activation, an alarm message, and an audible alarm.
 17. The methodof claim 14, wherein the caregiver alert changes as measured values ofthe first blood constituent move further from the altered alarmthreshold.
 18. The method of claim 14, wherein activating the caregiveralert comprises emphasizing on a display the measured values of thefirst blood constituent.
 19. The method of claim 14, wherein activatingthe caregiver alert comprises at least one of altering a size ofmeasured values of the first blood constituent displayed on a displayand alternately displaying and removing from display the measured valuesof the first blood constituent.
 20. The method of claim 14, furthercomprising: displaying on a display the at least one measured value ofthe first blood constituent and; displaying on the display a predictionindicator corresponding to the first blood constituent, wherein theprediction indicator indicates a predicted trend of measured values ofthe first blood constituent.
 21. The patient monitor of claim 7, whereinthe first blood constituent comprises at least one of oxygen saturation,fractional oxygen saturation, carbon monoxide saturation, methemoglobinsaturation, and total hemoglobin, and the second blood constituentcomprises a different one of the at least one of oxygen saturation,fractional oxygen saturation, carbon monoxide saturation, methemoglobinsaturation, and total hemoglobin.
 22. The method of claim 14, whereinthe first blood constituent comprises at least one of oxygen saturation,fractional oxygen saturation, carbon monoxide saturation, methemoglobinsaturation, and total hemoglobin, and the second blood constituentcomprises a different one of the at least one of oxygen saturation,fractional oxygen saturation, carbon monoxide saturation, methemoglobinsaturation, and total hemoglobin.